Complements or Substitutes? Technology Adoption and the Demand for Clinical Care: Evidence from Automated Insulin Delivery

Abstract: Whether medical technology reduces or increases demand for professional care is central to understanding its effects on healthcare utilization and costs. We study automated insulin delivery (AID) adoption among 1,608 adults with type 1 diabetes treated in four specialist clinics of the Italian National Health Service, 283 of whom adopt AID. Because adoption is clinically targeted and staggered, we combine risk-set coarsened exact matching with a staggered event-study design. Matching retains 181 adopters with comparable untreated controls. We further adjust for differential pre-adoption trends by extrapolating the untreated trajectory in event time. After adjustment, AID adoption is associated with greater routine outpatient engagement. The estimated effect on the probability of a diabetologist visit is 16.3 percentage points one semester after adoption and 39.3 percentage points four semesters after adoption, relative to a 55.2% visit probability in the semester before adoption. HbA1c testing and a broader process-of-care index show similar positive patterns, although the evidence is less precise. The visit estimates remain sensitive to the trend-extrapolation assumption and should therefore be interpreted conditionally on that restriction. The findings are consistent with a task-based view in which automation substitutes for routine dosing decisions while complementing clinical labor through interpretive, adjustment, and supervisory tasks. Patient-facing automation may therefore reorganize rather than simply reduce healthcare use.